Implicating factors in the increase in cases of central precocious puberty (CPP) during the COVID-19 pandemic: Experience of a tertiary centre of pediatric endocrinology and review of the literature.

Sexual development is a complex mechanism activated by the hypothalamic-pituitary-gonadal axis. Over the last one hundred years there has been a decline in the age at puberty onset in industrialised countries. Some Italian studies showed an increase in diagnoses of Central Precocious Puberty (CPP) during the COVID-19 pandemic. It is thus supposed that in this period there was an increased impact of factors that can influence pubertal development. Our retrospective monocentric study aimed to confirm the existence of this phenomenon and analysed possible related factors. We retrospectively evaluated clinical, laboratory, radiological and ultrasound (US) data of 154 girls referred to our Tertiary Centre of Paediatric Endocrinology from January 2019 to April 2021 for different forms of Precocious Puberty. We subdivided the cases into subgroups according to the final diagnosis: CPP, Early Puberty (EP), isolated thelarche and isolated pubarche. The observation period was subdivided into: Period 1, before lockdown (1 January 2019 - 8 March 2020) and Period 2, lockdown and the following months (9 March 2020 - 30 April 2021). Period 2 was further divided into "restrictive lockdown period" (Period 2.1) (March 2020 - 14 June 2020, in which the schools were closed) and "less restrictive lockdown period" (Period 2.2) (15 June 2020 - 30 April 2021). We analysed data regarding the use of electronic devices before and during lockdown in a group of girls with CPP diagnosed in Period 2 and we compared the data with that of a control group. Our data show an increase in the number of new diagnoses of CPP during lockdown and in the following months, compared with the previous period. We also detected a higher use of PCs and smartphones in girls with CPP diagnosed in Period 2, compared with the control group. The percentage of the presence of endometrial rhyme detected during the pelvic ultrasound was higher in girls with CPP in Period 2, compared with the previous period. Based on our data we assume there was an environmental effect on pubertal timing that calls our attention to factors such as food, use of electronic devices and stress. We will need further studies to better understand this data.

Reverse Retrograde Approach: An Alternative Method for Ipsilateral Access to the Superficial Femoral Artery.

Access for endovascular treatment of the superficial femoral artery (SFA) is usually gained through an antegrade approach from the ipsilateral common femoral artery (CFA), or by crossing over from the contralateral CFA. In this technical note, an alternative method, based on retrograde access of the ipsilateral iliac artery (IA), and conversion into an antegrade approach to the SFA, is described. Successful reverse ipsilateral catheterisation was obtained in 15/16 patients. Calcification of the CFA and IA required a crossover approach in one case. There were no complications related to the technique, except for moderate bleeding in relation to the deployment of a closure device.

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Iron absorption by humans and swine from Fe(III)-EDTA. Further studies.

Studies on iron absorption from Na59Fe-EDTA in humans have shown that only a small proportion of the iron absorbed is excreted by the kidney, less than 1% of the dose administered. The pathway of Na55Fe-[2-14C]EDTA absorption and excretion when administered orally was studied in swine. A certain proportion (about 5%) of the 55Fe is split from the EDTA complex in the lumen of the gut, absorbed mainly from the pylorus and upper jejunum, transferred to plasma transferrin and then incorporated into the circulating hemoglobin. A small proportion of the iron absorbed, less than 1% of the dose administered, is excreted by the kidney, to a degree similar to that excreted by humans. The rest of the iron is eliminated in the feces, about 3% in a soluble form possibly still bound to EDTA and the greater part, about 92%, in an insoluble form. About 5% of the 14C is absorbed almost uniformly along the pyloric duodenal and jejunal mucosa, then transferred slowly to the plasma and excreted by the kidney within 48 hours. The rest of the 14C was excreted in the feces, about 80% in a soluble form and 20% in the insoluble fraction.

O2 transport in the alpaca (Lama pacos) at sea level and at 3,300 m.

Five male alpacas native to high altitude, of approximately 40 kg, were studied first at 3,300 m and again after a 3-month sojourn at sea level. Measurements were made with the animals standing, unsedated and breathing air. Cardiac output was measured by the dye dilution technique. Blood gas tensions and contents were measured in arterial and mixed venous blood. Blood samples were also equilibrated with different oxygen tensions to construct O2-Hb dissociation curves. The P50 was 17.8 and 19.7 torr at 3,300 m and at sea level, respectively. The higher P50 values at sea level were associated with higher values of base excess. PaO2 was lower at 3,300 m but SaO2 was always above 90%. No significant changes in [Hb], Hct, Q, CaO2 and CvO2 with changes in elevation were observed. PaCO2 tended to be lower at altitude indicating a mild hyperventilation. The values of PvO2 were lower than those reported for other mammals but similar to those of the llama. A higher PvO2 was measured in the alpacas at sea level. The alpaca under conditions of chronic hypoxia presents only minor cardiorespiratory adjustments suggesting the possibility of tissue characteristics well suited for life at high altitude.